Republicans are trying to figure out what to change in Obamacare to make it work. I believe Republicans should change all the perverse biases built into Obamacare. The result would be a small but important dent in Repairing the Healthcare System.

It is best to start all over again with a bill that puts consumers in charge of their healthcare dollars. Consumers must be responsible and own their healthcare decisions and healthcare dollars. Consumers must drive the healthcare system in order to have reduced costs, increased efficiency of care and competition among stakeholders.

Obamacare is a political strategy by progressives to get more power. It is not about improving delivery of healthcare.

“It is about "redistribution of wealth"... or, by its more common name, "SOCIALISM.”

Republicans do not understand this. They don’t have the courage to call out President Obama or the Democrats.

Democrats cannot or do not want to understand the power of market based consumer driven healthcare because their ideology of central government control of healthcare does not allow it.

Consumers, taxpayer and voters must drive the change to a better, more cost efficient and less dysfunctional healthcare system.

Obamacare’s basic theme is built on hospital ownership of physicians’ practices. If hospitals or hospital systems own all the physicians’ practices in a community, the government has to only negotiate prices with the hospital system. The central government can then control a community and decide on access to care and the rationing of care of the community’s citizens.

The hospital receives a bundled reimbursement for a disease encounter. The hospital divides the reimbursement between the doctor and the hospital.

Once physicians are in the employ of hospitals, the government and hospital systems think that the non-compete clause will hold up in court and physicians will be afraid to leave the hospital systems.

Hospitals think they can lower the salary of physicians during negotiations for renewal of physician employment contracts since physicians will be afraid to leave the hospitals’ employ.

I’ll bet if a group of physicians decided to leave at the same time, the hospitals would be in the trap hospitals set to apply to physicians. Physicians should wake up. Some physicians have.

These are some of the perverse biases Obamacare has created against physician practices and patients.

The biases created against groups of private practitioners and to the advantage of hospital systems costs government and healthcare insurers more than it would if there was a level playing field for practicing physicians. It would create market place competition. Consumers and taxpayers absorb these government overpayments.

A common belief is that the payment system must be changed from a fee for service system to a bundled payment system.

HMOs failed in the 1980’s and early 1990’s because of the pressure of patient and physician dissatisfaction with the quality of care that was provided with a bundled payment system.

Accountable Care Organizations (ACOs) run by hospital systems are the organizations that will take risk and accept a bundled fee. It is similar to the HMO’s that failed previously.

ACOs will fail because it is difficult to predict medical risk. The increases in premiums are the result of the insurance industry’s miscalculation of risk.

Physicians are not willing to take on the risk of patients’ compliance and adherence. Physicians are not mechanics that put a new part in patients and then patients are fixed.

The popular notion is payment reform requires coordinated delivery of medical care in an Accountable Care Organization in which a single institution owns the physicians.

Everyone knows the physicians are at risk. Much of that risk depends on the patients’ responsibility to understand their illness and their behavior toward caring for that illness.

Obamacare is biased against less centralized engagements where independent doctors enter into contractual relationships with their patients. The government has imposed less reimbursement and more paperwork for these independent practices to discourage them from remaining in private practice.

Private practitioners cannot afford to participate in reformed payment plans. Private physicians need complex IT infrastructure in order to comply with the rules and regulations needed to participate in the complex payment reform structure that shifts risk to physicians.

The problem is hospital systems cannot control physician’s medical judgments. Medical judgments are complex and cannot be boiled down to cookbook decision solutions.

Obamacare also provides favorable anti-kickback provisions to hospital systems only when hospital and physicians qualify as Accountable Care Organization. ACO qualification is dependent on requirements that create the same need for physical infrastructure and bureaucratic overhead that is hard to replicate outside the hospital setting.

In the end physicians shouldn’t care to be in an ACO because their freedom to practice medicine according to their medical judgment could be impaired.

However, many physicians still feel compelled to join hospital systems so they are not left out of the “new age.”

Those physicians who do not participate are joining the surge of interest in the fast growing concierge medicine phenomenon. Consumers want someone to relate to them and not to be a commodity in a failing healthcare system.

I know of only one group of physicians in a small city in Texas who have supposedly taken control of the hospital and enjoy government provided benefits for developing an ACO.

The hospital is dependent on the organized physician group rather than the hospital taking over the physician’s group and dictating how these physicians should practice medicine.

In order for real reform to occur Congress must level the playing field between hospitals and independent private practice physicians. Only then will there be a competitive system where both hospitals and physicians will compete for patient pools.

Congress has to put consumers in the drivers seat, not hospital systems.

The government could set up a new class of “independent risk managers” to help groups and individual physicians analyze and manage risk.

Managing risk depends on patients assuming responsibility in the participation in managing their diseases.

Hospital systems do not evaluate risk very well. Neither does the healthcare insurance industry or the government.

Government should be the facilitator of improving care, not the manager of the healthcare system.

Another simple solution to increasing costs would be to provide physician owned private groups and individual physicians with the same reimbursement provided to hospitals and hospital owned physicians.

Things as common as heart scans ($749 versus $503), colonoscopies ($876 versus $402) and even a 15-minute doctor visit ($124 versus $70) all pay more when done by a hospital-based doctor than a privately owned medical office.”

This is true in all coding categories. The difference produces a sizable profit incentive to the hospital at a great cost to government.

Hospital systems are driven to buy physicians’ practices to take advantage of the difference since money-making long inpatients hospital stays are becoming a thing of the past with new advances in medical and surgical care.

The profit margin from owning brick and mortar is shrinking and the profit from owning intellectual property and surgical skills is increasing. Hospitals want to take advantage of this phenomenon.

Why is the Obama administration doing this?

Once the hospital own the physicians in the community the government can then squeeze the reimbursement to the hospital system. Hospital systems will have no option but to accept the reduced reimbursement.

It is called “got you in checkmate.”

It has happened before. This strategy has never worked.

When will the government ever learn?

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

The implementation of Obamacare has progressed at a slow pace because of the Obama administration’s lack of understanding of physicians’ and patients’ needs.

In order to adjust to plans and policies not working as the Obama administration visualized, the administration has had to adjust policies, plans and costs.

There is no question in my mind that medicine is primed for a new age because of the advances in science, information technology and medical technology.

In my view Obamacare is a bad law. It is inhibiting progress on these upcoming advances. President Obama is trying to control provider behavior by measuring it in microscopic detail. He is trying to shift the cost and risk of patient care to physicians and patients in order to reduce costs by decreasing risk to the healthcare insurance industry.

He is trying to commoditize patient care. Obamacare is destroying the patient/physician relationship.These relationships are vital to the therapeutic index of any treatment.

Many of the Obama administration’s policy adjustments have led to uncertainty. Uncertainty of ad-lib changes in policy inhibits progress, increases costs, and produces anxiety and inefficiency. .

For many, the computer systems are too expensive even with President Obama’s promise of financial supplementation. It is difficult to change coding for treatment and procedures from 18,000 codes to 88,000 codes.

The reason for this coding change is for government to evaluate the work of physicians and hospitals microscopically in order to determine how much to pay them.

The government does not trust physicians. Physicians do not trust the government. In order for any system to work effectively and efficiently there must be mutual trust. Absence of mutual trust leads to more fraud and abuse, not less

In 2003 the government set up a defective measurement system intended to reduce physician reimbursement by about 5% per year. Each year the congressional “doctor fix” relieves physicians of the decrease in reimbursement from Medicare.

However, each year’s “doctor fix” is cumulative. This year physicians face a 30% decrease in reimbursement despite the fact that many reimbursement codes have decreased reimbursement yearly in addition to the looming 30% decrease in reimbursement.

The policy has led physicians and physician groups to hold off on investing in coordinated care and technology. Additionally, physicians have a dim view of their return on investment for two reasons. Physicians cannot pass the cost of these new systems on to patients or the insurance industry because of the government’s pricing policies and because the government does not pay for much of the coordinated care or education of patients with chronic disease.

As a result of this uncertainty and anxiety physicians are selling their practices to hospital systems. Many physicians are salaried. These physicians figure the hospital system can have all the aggravation. Other physicians are paid a salary plus a bonus determined by productivity. This does not eliminate the complaint that physicians have incentive to do more testing.

Many hospital systems have taken advantage of physicians’ intellectual property and surgical skill over the years. There has been a tradition of local adversarial relationships between physicians and hospitals. The hospitals’ tactics have not been obvious to many physicians. Many hospital policies are not transparent to their hospital-based physicians.

However, when it becomes apparent, the animosity between the physicians and hospitals becomes deep seated. The passive aggressive behavior of physicians inhibits the hospital system’s growth and development.

This year the temporary Medicaid reimbursement increases have expired. The Medicaid rolls have increased. The PCPs were correct. President Obama did not fix the Medicaid doctor shortage. It has only made it worse.

The number of physicians seeing patients with Medicare coverage has also decreased because of decreases in Medicare reimbursement despite the upcoming 30% decrease in Medicare payment.

President Obama ’s recent unilateral decision to alter immigration policy and provide these immigrants with healthcare insurance will only make things worse.

The ad-lib change in healthcare policy is driving physicians crazy. Many are frightened about their professional future in practicing medicine.

President Obama thinks his job is to transform America. He never defined what transforming America means.

Americans assumed he would make America a better place to live for the average citizen.

In the last six years the average American has not had job security, healthcare security or a better standard of living. President Obama keeps telling Americans they have a better life.

President Obama saying it does not make it so.

Americans are starting to perceive reality and do not believe him or in him anymore.

In February 2014 I published the following blog. The tactic President Obama uses is to present a half-truth that is not close to the truth. He confuses Americans so they do not know what to believe. They stop paying attention to what is happening to them and society. They do not search for the truth until it affects them directly.

President Obama’s fantasy is now affecting the hard working middle class. They now know he lies to them. They feel they have been taken for fools.

In the last few weeks he has been putting out false narrative about how well Obamacare is doing.

Last years blog will set they stage to understand the way the tactic has been played over and over again.

President Obama uses these tactics over and over again to attack his opponents, obfuscate reality and confuse the public.

The public has figured out President Obama out. Reality is now in healthcare and Americans are feeling it.

The middle class independents voters are feeling it the most.

President Obama’s opponents have not figured out how to neutralize the Alinsky formula.

If someone points out the truth he is attacked, belittled and marginalized. President Obama is using executive powers to attack the constitution in order to restrict Americans’ rights to freedoms.

The most recent FCC foray to determine the quality of news reporting was cancelled by the uproar about the attack on free speech.

President Obama has tried to shift public attention away from Obamacare by bringing up many topics at once.

The traditional media goes along with this because President Obama is the number one newsmaker. The media have only a limited time or space to cover topics.

Let’s face it. These important topics are not entertainment. They are boring.

A story that floored me was President Obama’s his austerity claim. He said his new budget would finally end the dreary "era of austerity."

Did he think increasing Americans national debt $6 trillion dollars over 5 years was austere?

“ The federal government will still spend $561 billion more this year than it did in 2008.”

I was under the impression that the Republicans took a shellacking from President Obama once again by the way the recent budget deficit and debt ceiling resolutions were reported. The opposite is true.

President Obama wanted the sequester abolished, roughly $2 trillion more in spending, and almost $1 trillion in higher taxes over the next decade.

The latest budget deals delivered none of that. While the sequester was relaxed, all the additional spending was offset with no higher taxes.

In the last few weeks President Obama has been telling his base over and over again that Obamacare is going to be a non-issue in the November 2014 elections. He told Bill O’Reilly in his Super Bowl interview that 6 million people have already received insurance.

http://youtu.be/9uzJYlbhH54

Both were lies. It doesn’t seem to bother him to lie.

Dick Durbin, the second man in the senate, told a Sunday morning talk show that 10 million have signed up by end of January.

On February 25th President Obama announced that 4 million have signed up. He did not say how many of those were on Medicaid, how many bought private insurance, how many lost their insurance because of Obamacare, how many bought private insurance on the health insurance exchange and how many never had healthcare insurance.

He has used the 6 million over and over again even though he received 4 Pinocchio’s from the Washington Post fact checker.

The traditional media just publishes what he tells them even though they have stories with facts that contradict his pronouncements.

President Obama has henchman at the New York Times. Paul Krugman is the chief.

He makes pronouncement without facts.

His February 23, 2014 article “Health Care Horror Hooey” is one of those articles. He starts by brow beating his audience about the death tax (Estate Tax).

The problem in my view is people paying estate taxes are being taxed a second time on the same money.

I do not care how rich a person might be the government should not be entitled to tax money twice.

And now they’re trying a similar campaign against health reform.

This statement is nonsense

“I’m not sure whether conservatives realize yet that their Plan A on health reform — wait for Obamacare’s inevitable collapse, and reap the political rewards — isn’t working.”

My sense is Paul Krugman views conservative as shiftless idiots. He presents no proof as to whether Obamacare is working or not. He simply declares Obamacare isn’t collapsing.

“But it isn’t. Enrollments have recovered strongly from the law’s disastrous start-up; in California, which had a working website from the beginning, enrollment has already exceeded first-year projections.”

Mr. Krugman ought to read his own newspaper. The New York Times reported that California does not have enough physicians participating in Covered California to service its subscribers. Many subscribers have not paid their first premium.

The mix of people signed up so far is older than planners had hoped, but not enough so to cause big premium hikes, let alone the often-predicted “death spiral.”

There is absolutely no information about age mix and health risk available for Covered California that I could find.

It is clear the administration is withholding this information.

In fact, Covered California has had to close its website in order to try to cover the discrepancies.

Paul Krugman claims insurance premiums and deductible have not gone up. I think he ought to look at the health exchange insurance premiums and deductibles for the individual market on the health insurance exchange.

He does not talk about the reasons for all the waivers given by President Obama. He does not talk about the congressional exemption.

He does not speak about the exemption delay for the corporate insurance market. Why not?

Millions of families will lose their insurance coverage and be driven into the Obamacare health insurance exchanges or face government penalty.

Paul Krugman is being intellectually dishonest with the American people. The American people are being forced into an entitlement program they do not want. This is not “Health Care Horror Hooey Mr. Krugman. It is reality. At the time of Krugman’s article a CMS report was publish that found 65% of small businesses that offer insurance will likely see their premiums rise thanks to ObamaCare. That translates into higher insurance costs for 11 million workers.

“No doubt, Obamacare boosters will charge that this information is from some right wing think tank.“

The Obama administration immediately started shouting foul to the CMS study. They said the study was incomplete and the conclusions will change.

One study, for example, found that 63% of small employers in Wisconsin will see premiums jump 15% because of ObamaCare. A separate study found that 89% of small companies in Maine would see rate hikes of 12% on average.

Another, by consulting firm Oliver Wyman, concluded that ObamaCare would push up small group premiums nationwide 20%.

As soon as the CMS report came out, Democratic leaders rushed to the microphones to dismiss it.

House Minority Leader Nancy Pelosi's spokesman said it was "incomplete" and that the GOP would use the report "to mislead and deceive Americans."

President Obama, the American people got it. After all the lies, deceptions and misrepresentations we know what you are doing with your people and your shills.

We do not trust you!" Feburary 27 2014

In February 2015 President Obama’s misdirection continues. There is a lack of transparency about the 2015 www.healthcare.gov enrollment figures. The goal for enrollment is rigged. Last year is was initially published that there were 9 million enrollees.

The 6.8 million figure included the people who have lied to get higher subsides. Presumably they lied with the help of President Obama’s Navigators who receive $48 an hour from the government to help people complete their applications.

The money spent is being wasted. The taxes for the funding of Obamacare’s 6.7 million enrollees is increasing as it attempts to increase enrollment to 9 million down from the original enrollment goal of 12 million.

I received a note from a reader who said Obamacare is here to stay. It is what it is. We should try to repair Obamacare rather than repeal it and replace it.

In my view Obamacare cannot be repaired. It was created to destroy the healthcare system. President Obama’s goal is to replace Obamacare with a government controlled single party payer system.

The result will be to control and restrict access to care and ration care. It is a step on the way to restrict citizens’ freedoms.

Every week indications of Obamacare’s failures appear but are kept under the public’s radar. The Obama administration spins the facts and the mainstream media’s regurgitates that spin.

The Obamacare signup figures as complied by http://acasignups.net as of 12/30 2014 are very different that the administration’s spin to the media that the open enrollment period is going great.

Obamacare’s enrollment is still 1 million below estimate at this point

HHS finally announced that approximately 87% of Americans who selected 2015 health insurance plans through HealthCare.gov in the first month of open enrollment are receiving financial assistance to lower their monthly premiums. This percentage of subsidy awards is higher than in the same period last year.

The number is significant because, should the U.S. Supreme Court decide against the Obama administration in the King v. Burwell case it is scheduled to hear in March, consumers living in the 37 states relying on the subsidies from HealthCare.gov could lose their premium subsidies.

Another problem is even with the subsidy the people who received them cannot afford the insurance deductible. They do not seek medical care.

HHS has yet to disclose if it has a contingency plan should a ruling come down that only those who buy Obamacare insurance through state exchanges are eligible for coverage subsidies.

The CMS Innovation Center was established by section 3021 of the Affordable Care Act (Obamacare) for the purpose of testing “innovative payment” and service delivery models to reduce healthcare expenditures while preserving or enhancing the quality of care” for those individuals who receive Medicare, Medicaid, or Children’s Health Insurance Program (CHIP) benefits.

To date the CMS Innovation Center has awarded $2.6 billion through September 2014 to hospitals, doctors and others through nearly two dozen programs that tested new ways to deliver healthcare and pay for it.

“Results of those programs some underway since 2011including more than 60,000 providers and 2.5 million patients in Medicare, Medicaid and the Children's Health Insurance Program, are largely not yet available, the Innovation Center said in its second report to Congress.”

The ICD-10 diagnostic and procedure codes were to be implemented two years ago. It appears to be going nowhere because it is too complicated. President Obama will probably delay it again.

The change toICD-10 from ICD-9 has been pushed forward at least three times. It is too complicated. It is designed to commoditized medical treatment and eliminate physician judgment. Codes have been increase from 18,000 (complicated enough) to 68,000. Neither physicians nor their unsophisticated computer systems can comply correctly.

The Obama administration is still pushing for its execution and wasting money yearly. Physicians cannot and will not comply with this government regulation.

The GRF is not fixed yet. Congress delays the reductions in reimbursement due to this defective bureaucratic formula each year and adds the percentage reduction in physician reimbursement to next year’s reimbursement reduction.

This year physicians can expect another 4% reduction for a total of 32% since 2002. We will see if congress fixes this defective formula this year.

Physicians are struggling to deal with new measurements to improve quality and deal with a myriad of new changes in Medicare and Medicaid rules and regulations.

Two years ago in order to attract more physicians to accept Medicaid to care for the growing number of enrollees in Medicaid, Obamacare increased Medicaid reimbursement by 40%. The increase in reimbursement was to last only until January1, 2015 and then revert to the 2012 reimbursement schedule.

Those pediatricians, family practitioners and internists were faked out once more by Obamacare and President Obama’s promises.

The biggest pay surprise to physicians will come when the old reimbursement returns. Poor Americans on Medicaid will suffer when they cannot find a physician.

The dice have been loaded against the American people by the rules and regulations in Medicare and Obamacare.

Patients liked their doctors. Once they discovered that they could not keep their doctors under Obamacare they became angry at President Obama for lying to them. The soon to be released new payment rules will increase the anger.

These complexities are in effect ending independent medical practices. This has been intentional. The Obama administration doesn’t want to control 600,000 independent physicians. It wants to deal with the hospital systems the are involved with. The hospital systems can then deal with the doctors.

Republicans are looking for a compelling alternative to Obamacare.

Just as Obamacare was forced through congress, President Obama is trying to force how medicine is practiced in America down the throats of Americans.

It is consistent with Jonathan Gruber’s view that Americans are to stupid to understand what is going on. It follows that Americans are too stupid to be responsible for their own care.

Americans want freedom of choice. They do not want the government to tell them what to do.

Physicians by nature and education are competitive. Competition leads to improvement of the delivery of medical care.

All medicine is local. The alternative to Obamacare is to have local completion among physicians and permit patients to choose their doctors.

The answer to the Republican’s dilemma is right in front of their eyes.

A real Republican alternative to Obamacare would support physician ownership of independent medical practices and preserve local competition between doctors and maintain choice for patients.

Obamacare’s promotion of large hospital systems with salaried physicians eliminates physicians competing for patients. The lack of physicians competing for patients destroys the physician/patient relationship.

Physicians listen to patients if patients have a choice. The interaction is a partnership called the patient /physician relationship.

This solves the problem of President Obama’s lie. “If you like your doctor you can keep your doctor period.” Patients choose their doctors.

Dr. Donald Berwick and Jonathan Gruber’s view the consolidation of physicians and hospital systems as a necessary step to enable payment liability onto providers through hospital systems and away from government programs such as Medicare and Obamacare.

President Obama does not understand that doctors are not stupid either. At the moment physicians feel financially cornered by the government and the hospital systems and are joining hospital systems as a temporary means of surviving.

President Obama also does not realize that over the last 50 years there has been a build up of physician distrust for most hospital administrations.

Most administrators have tried to repair that mistrust but it has not been very successful. Hospital systems have been trying for years to own their physicians’ intellectual property and surgical skills for their hospital system’s profit. It is all about economics. Patient care is secondary.

As hospital systems consolidate competition will be eliminated. Then hospital systems will realize they are losing money because of the risk they agreed to accept from the government. Hospital systems will demand more money from the government or consumers or go out of business.

Who loses?

Patients lose, taxpayers lose, and the American healthcare system loses.

The abuses of the healthcare system by all the stakeholders must be fixed. It will never be fixed by forcing stakeholders to fix it. It will only be fixed by aligning incentives of all the stakeholders. Consumers must lead the way.

It has also been reported that hospital systems are complaining that they are losing money on their physicians in these integrated systems.

Hospital systems are dropping out of the Obamacare Accountable Care Organization programs. There have been reports that salaried physicians are less productive that independent practicing physicians.

I believe in the team approach to the management of chronic disease. The patient must be at the center of the team with the physician being the head coach or manager and his team being an extension of the physician’s care.

Medical decision making entities must not be the insurance company or the government.

The idea that integrated systems with salaried physicians leads to increased economic efficiency, better quality of care and clinical outcomes than small independent private practices never made syllogistic sense to me.

Patient care becomes depersonalized in large hospital systems. Both patients and physicians become commodities in systems focused on the bottom line.

Small practices have the advantage of providing a personal style of care. Consumers want that comfort when they are sick. They want someone they know who is going to listen to them and talk to them.

In a private setting physicians can practice the way they want, without interference by a large, impersonal organization driving efficiency.

If a physician in private practice does not satisfy the consumer’s need the consumer can leave the practice and go somewhere else.

"When you work closely with patients and empower them, they are going to make better choices," said Craig C. Koniver, MD, a solo family physician in North Charleston, South Carolina. He said a team of caregivers at a large practice will not have the same impact, because none of them are as close to the patient as he is.”

Health Affairs published a study in August 2014 looking at primary care physicians in small practices and “ambulatory care sensitive” admission rates. The study included such conditions as congestive heart failure in which admission to the hospital can be preventive by high quality primary care. The patient relates positively to the physician and the physician relates positively to the patient (positive patient/physician relationship).

“The study found that practices with 1 to 2 physicians had ambulatory care-sensitive admission rates fully 33% lower than practices with 10 to 19 physicians.”

This is not the only study that shows that small independent private practices can deliver just as high or higher quality of care than large integrated hospital systems with salaried physicans.

“ A 2013 study[2]showed that small practices in general had slightly lower hospital readmission rates than large practices.”

Additionally, “a 2012 study[3]looking at practices ranging from 5 to 750 physicians found that the smaller ones had fewer ambulatory care-sensitive admissions and lower overall costs of care for diabetes.”

All three studies turned a piece of conventional wisdom on its head; that large practices, with their care management teams and sophisticated clinical information systems, produce better clinical outcomes.

Republicans should start presenting alternatives to Obamacare. The alternative must provide consumers with what they want rather than systems that let the government to tell consumers what they are going to get.

This is a message for the Republican majorities in the House and Senate. Obamacare is a disaster built on a failed ideology, deceptions and lies.

Obamacare started off with lies and continues to deceive the American public.

Its emotional seductions have also deceived many physicians.

All one has to remember is Jonathan Gruber’s statement about the lack of transparency being a powerful political tool. Gruber said given the lack of transparency, the public is too stupid to figure out the truth.

President Obama told us; ”If you like your doctor you can keep you doctor, period.”

This statement was not true for an instant. President Obama knew it but ideology trumps reality. Many have blamed Obamacare’s failure on President Obama’s inexperience as a manager. This is not the reason.

The failed progressive ideology of big government controlling choices and freedoms of the American people is the reason for Obamacare’s failure.

Last week, Senator Charles Schumer (D-N.Y.) admitted the passage of Obamacare was a mistake. Not surprisingly, the mainstream traditional media has not mentioned Schumer’s admission.

The mainstream media has been a shill for Democrats and President Obama. It has helped the Obama administration keep the truth from the American public.

President Obama keeps the American public uninformed with the help from the traditional mainstream media. His goal is central government control of Americans’ choices and freedoms. President Obama’s support is derived from his appeal to Americans’ emotions and not from the facts.

His problem is Americans are not stupid. They can separate reality from appearance when they pay attention. Obamacare is now affecting them directly and they are paying attention.

As a result of Obamacare deductibles have increased beyond affordability. Consumers cannot afford to utilize their “healthcare insurance” until absolutely necessary. The result will be higher costs when patients are forced to use the insurance because of the development of complications from a chronic disease.

In 2008, pre Obamacare, the US had seen a drift downward in health-care spending.

The downward trend began to reverse as Obamacare first officially launched in October 2013. In the fourth quarter of 2013, health-care spending rose 5.6 percent, far above the 2.6 percent growth rate of the economy, to which it significantly contributed.

“The rapid increase in spending does not indicate that the system is working to lower costs, an absurd if not Orwellian construct by President Obama.

“Nor is the debate “over,” no matter how many times Obama claims otherwise. Too bad the White House chose not to take advice from National Journal’s Ron Fournier.

“The president risks insulting a vast majority of Americans by dismissing their concerns with a consultant's talking point,” Fournier wrote before the economic figures were released, “and Obama can't afford any more blows to his credibility.”

Consumers are tired of President Obama’s lies. He has lost all credibility with the American public.

The Obama administration keeps telling us how well Obamacare’s Accountable Care Organizations are doing. The Obama administration keeps saying hospital systems must set up integrated healthcare systems (ACOs) to increase the quality of care.

President Obama refuses to believe that even though the ACO model sounds great its successful execution is difficult to impossible.

The chances for ACOs to succeed is not only dependent on the hospital system’s ability to decrease utilization, it is heavily dependent on patients taking responsibility for their own care. Patients must follow instructions.

President Obama believes he can lie his way out of reality. The American public is not buying these lies any more.

Republicans must focus on the reasons for the obvious failures of Obamacare.

Consumers want to have freedom of choice. They do not want the government to control them.

Republican must focus on creating programs to provide incentives for consumers to be in control and responsible for their health and healthcare dollars.

Republican must focus on ways to permit consumers “to keep their doctors if they like their doctors period.”

President Obama and CMS have been extremely quiet about Health Insurance Exchange enrollment since enrollment opened November 15,2014

President Obama reported that on opening day the health insurance marketplace performed much better than last year. However, some consumers reported long, frustrating delays trying to buy insurance and gain access to their own accounts at HealthCare.gov.

Twenty three thousand is a low number for a 45-day enrollment period with four days each at Thanksgiving and Christmas. It is only 1,035,000 enrollees (45 x 23,000). We do not know if they are new or old enrollees.

Ms. Sylvia Burwell has given us signals previously that all is not well with Obamacare.

It turned out that 65% of those approved for subsidies originally had the subsidy reduced when they could not verify their claimed income.

The American taxpayers, who are responsible for the subsidy (tax credit), were never told how the government was going to collect the government over payment. Taxpayers were never told the amount of payment due from people who received the invalid subsidies.

How many of those over subsidized people dropped out of Obamacare because they could not afford the premium or the deductible.

How many enrollees remained from the 8 million claimed to have enrolled?

Somehow the published number of enrollees dropped to 7.3 million. Did the decrease from 8 million to 7.3 million include the over subsidized dropouts?

I should think an inspector general or someone in congress would start connecting the dots.

I would think the CBO would recalculate their estimates.

I should think someone in the press would sense there was something fishy and start investigating.

The public has not yet seen any numbers proving Obamacare’ s viability or it’s bending of the cost curve.

We have seen patients complaining that they cannot afford the 6-10 thousand dollar deductibles of the health insurance policies. People have realized that they are not covered by insurance until they reach their deductibles. People have been hesitant to get necessary medical care in order to avoid paying the deductibles.

The Obama administration claims to have reduced healthcare costs. The administration does not count the patient’s deductible costs (out of pocket costs) in their bogus calculation of costs to the healthcare system.

The avoidance of follow-up care by patients with pre-existing illnesses (chronic diseases) is only going to lead to complications of those chronic disease and higher societal healthcare costs.

Lowering the goal for the number of enrollees to 9 million if only there are only 3 million valid enrollees that stayed in the system is going to be a very difficult task.

The changing of the date to begin open enrollment from October 1 to November 15 for political reasons is not going to help achieve the goal.

President Obama will probably extend the enrollment period from December 15,2014.

The Obama administration already announced the 2016 open enrollment period. It starts October 1 2015 and ends December 15, 2015.

There is a great website that calculates the estimated weekly enrollment and actual enrollment. Enrollment is not going very well. President Obama and his administration are very quiet about the enrollment. The mainstream traditional media is also ignoring enrollment.

As of 11/21/2014 the website reports confirmed enrollees for 2015 QHPs: at least 39,215 have enrolled as of 11/21/14 as opposed to the government estimated enrollees for 2015 QHPs of at least 410,000 as of 11/21/14.

No one is paying attention to the website. The Obama administration is not providing the information necessary for consumers to judge how well Obamacare enrollment is doing.

Ms. Burwell said that attention should be on all of the people who now have health insurance, rather than the miscalculation.

“While we understand some will be skeptical, our clarity that this is mistake and the fact that we have quickly corrected the numbers should give people confidence,” she said. “It is important to continue to focus on thefact that millions of Americans are getting affordable health care.”

The Obama administration persists in trying to distract the American public.

I think the Obama administration continues to believe, as Jonathan Gruber believes, that Americans are too stupidto understand what the administration is doing.

The administration wants to prove that the free market and private insurance cannot provide healthcare coverage for all that only total government control of the healthcare system can work.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

Open Enrollment for Obamacare started November 15th rather than October 1st. Open Enrollment for Health Insurance Exchanges was originally going start October 1,2014 to run until December 15,2014 for enrollees to have insurance on January 1,2015.

It think the open enrollment dates were delayed to prevent negative publicity for Democrats in the midterm elections. The date to close open enrollment has been moved to March 15th or March 31st2015 instead of December 31,2014.

President Obama is changing dates at will without congressional approval. It is creating confusion. Americans are giving up on following changes in the law.

President Obama probably believes, as Jonathon Gruber, that the American public is too stupid to follow all of his maneuvers.

It is impossible to know when open enrollment ends by following the mainstream media. I think it will end when the Obama administration has something to brag about despite what the law demands.

Early in 2014 it became clear to health insurance consultants that the healthcare insurance industry would raise Obamacare 2015 premiums by double digits (15-30%). The demographic of 2014 enrollees was actuarially unsound according to the healthcare insurance industry.

The Obama administration is presently boasting that the average premiums are going to rise only slightly in 2015.

Healthcare insurance companies are flocking to sell insurance in more markets rather than quitting the health insurance exchanges.

The Obama administration claims that Obamacare has created a competitive atmosphere for the healthcare insurance industry.

You bet it has. It has done the by creating subsidies for the healthcare insurance industry so it takes on no risk along with increased profit. This is the reason all the companies are fighting to get into the health insurance exchange market.

President Obama has offered to bail out the healthcare insurance companies if they do not make an adequate profit in the health insurance exchange.

The mainstream traditional media has not reported that Obamacare provided insurance company subsidies, nor have the subsidies been connected to the dampening of extreme increases predicted for premiums in 2015.

However, the decreases that are being reported by the Obama administration are deceptive.

Below is a CMS provided map of states and counties with either increases or decreases in premiums.

In about a fifth of the counties in states using the federal insurance exchange, premiums for the lowest-priced silver plans will increase by 10 percent or more. But rates for the same plans will decrease in all of Maine, Montana and New Hampshire, and most parts of Mississippi and South Dakota. NOV. 14, 2014

The published map belies the Obama administration’s claim that premiums have been, on the average, lowered. It does not take into account population density in counties where premiums are lowered or raised.

The premiums in some states could be lowered. However, the high deductibles included in these health insurance plans have not been lowered. The high deductibles are out of pocket expenses. The high deductibles continue to be unaffordable to many even thought these enrollees might receive sizable “tax credits? subsidies?” to help them pay for the premiums.

Private insurance plans bought through the health insurance exchanges are not private health insurance plans. They are plans that are subsidized by the government if the insurance bill goes over $45,000.

Who pays this government subsidy?

The taxpayers, by having their taxes increased.

Who makes the profit from this subsidy?

The healthcare insurance industry makes the profit because the insurance policies have been priced at high risk (Increased deductibles, and increased premiums for consumers not eligible for government subsidies).

"If the health plan has costs at 110% of the medical cost target [the costs that the insurer expects to accrue], it will be responsible for only 102.4% of the target (a 2.4% shortfall)-only about a quarter of its losses.”

There is little risk to the healthcare insurance company for being involved in the healthcare insurance exchanges.

The key point is President Obama had this written into Obamacare without telling taxpayers about it. I wonder if the CBO knew about it and calculated it into the original cost estimates of Obamacare.

There are many other deceptions that lie ahead. Now that the Jonathan Gruber controversy has increased the American public’s awareness of Obamacare deceptions Americans will begin to shout about the costs and rationing of care.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

The mid-term elections are over. The Republicans captured majorities in the House and Senate. The election was a clear repudiation by the people of President Obama’s policies.

President Obama has denied this reality. He has pledged to pursue his ideological goals that have hobbled the people and the country so badly.

The polls have indicated that the public is opposed to Obamacare and all of its unintended consequences.

We ain’t seen nothin yet. The unintended consequences are going to escalate starting with the delayed open enrollment season on November 15 2014. This opened enrollment was unnoticed, so Democrats did not suffer any blowback from Obamacare during the mid-term elections.

Larger categories of people and businesses will be affected by Obamacare’s rules and regulations on January 1,2015. Last year only people in the individual healthcare insurance market were affected.

President Obama continues to mock Republicans by telling them he will be happy to listen to them to see if they have a better idea than Obamacare.

Everyone knows he has no interest in changing or repealing his legacy healthcare law.

The majority of people are dissatisfied with Obamacare. All the Republicans have to do is come up with an idea that is compelling to all of the public. The power of public opinion can demand that Obamacare must change.

It has to be a simple idea. It has to teach consumers how to be responsible for their health and their own healthcare dollars. It has to educate consumers on how to drive the healthcare system and remove government from controlling their healthcare choices.

The basic problem with our present healthcare system is medical care is fragmented. In addition, all the stakeholders’ vested interests are misaligned.

President Obama, with his forced passage of Obamacare, has added to the dysfunction of the healthcare system. .

Obamacare is meant to be a step toward a single party system.

The government cannot afford, and the nation will not accept, a government controlled single party payer system.

Obamacare does not do anything to repair the distortions of to the system that have led to the dysfunction of the healthcare system pre Obamacare.

The most important stakeholder in the healthcare system is the consumer. Obamacare has marginalized consumers/patients even further.

It was hard for consumers to have notice the dysfunction in the healthcare system because only 20% of consumers use the healthcare system at one time. The remaining 80% thought their healthcare insurance was fine.

Since Obamacare was passed into law it is affecting everyone directly and they are starting to complain.

The current state problem are shown in the figure below.

A dizzying array of stakeholders is all fighting for a competitive advantage, or at the very least survival, in the dysfunctional current state.

Obamacare’s rules and regulations have made the current state more difficult for everyone. This is leading to the impending collapse of the healthcare system.

Republican Party should not tinker with legislation to try to fix Obamacare.

It should step in right now and educate the consumers about their consumer power. Republicans need to present a market driven solution that is easy to understand.

Once the public understands what they can do, it will change its attitude from the helplessness and hopelessness to an empowered reaction to do something to change the system.

There are many other things that need to be demanded by the public. I believe empowering the public to demand a market driven system is crucial to a viable and affordable healthcare system.

Almost all the stakeholders believe something must change. The centrally controlled healthcare system’s business model will not work or be sustainable. All one has to do it look at the VA Health System.

Consumers and businesses are becoming frightened and beg the government for help. The government will institute a single party payer system.

The result is that consumers will not be able or willing to tolerate a centrally controlled healthcare system.

As I see it, the nation has two choices: Alternative 1 and Alternative 2.

Alternative 1:

If we extend the course of our present healthcare system to a single party payer system (Alternative 1) the costs will escalate, and access to care will decrease. It is inevitable the rationing of care will occur.

Provider systems and administrative systems would have incentive to make its products attractive to consumers at the lowest price possible with the highest quality of care.

Consumers, by owning their healthcare dollars, would have the freedom and resources to choose. Government and its bloated and inefficient bureaucracies should not be making medical care choices for consumers.

Two things must happen. Republicans must teach consumers the advantages of a market based business model.

The Republican congressional majority must start teaching all the other stakeholders (physicians, hospital systems, the government, the healthcare insurance industry and Big Pharma) the advantages of this market-based system to their vested interest.

The alignment of vested interests must start right now and not down the line.

The Obama administration will dismiss the possibility of a successful market based system. Republicans must not be intimidated. Didn’t they win the election this time?

The Obama administration’s conclusions are based on ideology not past history, logic, fact or evidence.

The Obama administration and its followers will reject the possibility of success for an incentive driven system instead of a government controlled system.

Physicians must be provided with incentives to teach patients to be professors of their diseases.

4. The government outsources the administrative services to adjudicated Medicare and Obamacare billings. The government has little idea of the actual profits built into the fees the insurance companies charge the government. At intervals insurance companies are required to enter another bidding process. The government probably picks the lowest bidder.

It is not an efficient way to pick an insurance company. This is especially true when the government guarantees the insurance company‘s profit. The government does not know what the insurance company’s profit actually is. The profit is about 40% of the healthcare dollars.

President Obama’s ideological goal leads to these errors. His only concern is for the government to control the healthcare system.

Mechanism Design is a brilliant economic theory. If the theory was applied to the healthcare system it could solve much the system’s dysfunction.

When I wrote about Mechanism Design I felt that few people understood it.

What is it? Mechanism Design is the art and science of designing rules of a game to achieve a specific outcome, even though each participant may have a separate vested self-interest.

The design of the game is to align all the stakeholders’ vested self-interests.

Each stakeholder has an incentive to behave as the game designer intends. The game can then implement the desired outcome.

The strength of such a result depends on the solution concept used in the game.

None of the stakeholders’ vested interests are aligned in Obamacare except the vested self-interest of President Obama and his ideology.

The healthcare insurance industry thinks it has President Obama over a barrel.

Some of the hospital systems have figured out that they will be at the mercy of Obamacare.

Physicians already feel they are at the mercy of President Obama’s ideology.

Medical device companies and pharmaceutical companies have figured out they are dead already. It is only a matter of time until they cannot move. They are working around the system to come back from the dead.

None of the stakeholder’s vested interests are are aligned. This non-alignment will lead to destruction of the healthcare system.

Mechanism designers commonly try to achieve the following basic outcomes for stakeholders: truthfulness, individual rationality, budget balance, and social welfare.

With those four outcomes for stakeholders in the healthcare system one could get close to aligning stakeholders incentives.

Lodi Hurwicz’ point is the way to get as close to the most efficient economic outcomes is to design mechanisms in which everyone does best for themselves.

He says this can be achieved by sharing information truthfully (Price Transparency). It is easy to understand that some people can do better than others by not sharing information or lying in the short term. It will not serve all the stakeholders’ vested self-interest in the long term.

If everyone’s incentives are aligned you have a much more efficient economic system.

The example given in the military is defense contracting. If you agree to pay on a cost plus basis you have created incentives for the contractor to be inefficient.

If you do not you have incentives aligned and truthful information you create the incentive to be overcharged. Most people can do better by not sharing truthful information.

Many have observed that Obamacare has not been transparent or truthful.

If the rules of the game require truthful information you can get close to an efficient market driven solution.

The concept of Pareto efficiency means no one can be made better off without someone becoming worse off.

Hurwicz observed, as had others, that the dispersion of information was at the heart of the failure of a planned economy.

He observed that the free market economy can get us closer than central planning to incentive compatibility because in the end the consumer can drive the discovery of truthful information

A free market economy is by no means immune to the Pareto efficiency concept.

However, the free market mechanism was far less afflicted than central planning bureaucracy. A consumer driven system serves to force truthfulness.

Empowering consumers is the key to an efficient system. Customers determine success of an enterprise by creating demand. In a transparent environment they can get closer to incentive efficiency. They create the rules of the game for compatible incentive.

President Obama does not listen to the thoughts of the people who elected him. The middle class and independent voters under great economic distress and are frightened.

They are not better off than when President Obama took office.

They have no confidence in President Obama’s promise or desire to help them even though he continues to say he is out to protect the welfare of the middle class.

He claims to be for income equality, yet income inequality has increased in the last six years.

The people do not trust President Obama to make good decisions for them.

The people are scared stiff about the Ebola virus. They do not believe his explanations for letting people into this country from countries that have the Ebola epidemic are logical.

Why would he take the chance of letting more cases into the country? It is completely illogical to me.

People have felt the hysteria spreading throughout the nation because of one case. They are feeling the economic effects of so many people quarantined and held in isolation for 21 days. They see economic activity slowing down while they are experiencing a weak recovery after six years. Shopping malls are disserted.

The more he does the less the people trust him. The appointment of a public relations person as the Ebola czar is a mind blower to most people.

The Ebola czar knows nothing about medicine, or transmission of viral disease or human illness.

The Ebola czar knows everything about spinning disinformation.

This is not a good formula for increasing confidence and trust in President Obama’s ability to handle this crisis.

The people are noticing and reacting to crisis after crisis and scandal after scandal. President Obama calling an obvious scandal a phony scandal makes things worse for his being able to convince the voters that he knows what he is doing.

President Obama does not listen to the people who got him into office.

Is his agenda to ignore the people, the constitution and the law in order to basically transform this country?

Last January he said Obamacare would not be an issue in the midterm elections. He keeps on misleading the public about Obamacare.

He and his henchman keep saying Obamacare is working. Obamacare is a success. The evidence that it is not working is abundant. The people who voted for him are feeling its failure.

All these people are feeling the pain of President Obama’s policies. They also recognize that their wishes are being ignored.

People do not know what they need. Voters now know President Obama is ignoring them.

Yet he and Michelle have the audacity to travel around the country telling people “to vote for Democrats for congress to give Barack a chance to finish his work.”

A series of articles have appeared that express voters’s concerns about Obamacare’s failures.

Radius Global Market Research (Radius GMR did a survey that showed two-thirds of those insured via Obamacare will change healthcare plans in 2015.

Only 44% of Americans feel they are adequately about the benefits provided by Obamacare.

At present, eighty percent of people who get healthcare insurance through Obamacare receive government subsidies. These subsidies help with the healthcare insurance premiums for people earning up to $50,000 a year.

However, those people are responsible for the deductible under Obamacare. The least expensive coverage is for a bronze plan.

The average deductible from the Health Insurance Exchange is $5,081 for an individual and $10,386 for a family, according to HealthPocket.

A Silver plan (the next higher plan) had average deductibles of $2,907 for an individual and $6,078 for a family. The initial premiums are higher.

An average family making less than $50,000 cannot afford either deductible. A family making more that $50,000 per year without subsidy cannot afford the premium or the deductible.

People having a pre-existing illness will eat into the deductible that they cannot afford. Therefore they will avoid medical care.

The impact of the deductible is a surprise to people with preexisting illness. They do not have coverage until the deductible is met.

This creates stress on these individuals. It also represents a form of deception for these people. They thought they had good insurance coverage. President Obama promised them good healthcare coverage. He lied to them. They will remember the lie at the voting booth.

"The system is broken and I am out of here as soon as I can. I am tired of being used, abused and lied to. Has anyone here woken up to the fact that we are always the last ones to be considered in the equation of change?"

It is clear the primary stakeholders in the healthcare system (patients and physicians) feel deceived by President Obama.

I do not think they are going to let him finish his work. They will stop him at the voting booth in November.

It will be difficult for the country to survive another two years of Harry Reid’s obstruction if the Democrats hold the senate.

Obamacare remains a big issue among many people despite President Obama’s promise that everyone will like Obamacare by the November election.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

As time goes by the implementation of Obamacare (ACA) becomes more bizarre.

The start of the 2015 enrollment period in Obamacare’s health insurance exchange program was delayed from October 1, 2014 until November 15, 2014.

The reason for the delay is obvious. The Obama administration fears another disastrous enrollment rollout just before the midterm elections.

President Obama is protectingDemocratic candidates who voted for Obamacare from the political fallout.

The enrollment period is supposed to end December 31, 2014 in order for insurance coverage to start January 1, 2015.

This enrollment period is very short. The Thanksgiving and Christmas holidays will make it even shorter.

President Obama will probably delay the end of the enrollment period once again by executive order.

The Obama administration must also deal with people who lied about their enrollment qualification. Hundreds of thousands could not show proof of income or eligibility for government subsidies for their insurance for 2014.

The government has not published any data about the number of people who have been disqualified for providing false information.

These people owe the government money. They cannot afford to pay the amount owed. Is the government going to let these underpayments disappear?

The Obama administration also announced that anyone who was enrolled last year does not have to do anything. They will be enrolled automatically in 2015.

At what price? Premiums will be higher than last year. Enrollees might not be able to pay the higher or unsubsidized premiums.

Insurance premiums in the health insurance exchanges are going to increase at least 10% in 2015 despite the Obama administrations guarantee, through its reinsurance plan, that it will cover any of the healthcare insurance industry’s claimed losses.

Problems were compounded this week by a CMS announcement that they will not publish the health insurance exchange premiums until November 15,2014.

Medicare premiums are also going to increase dramatically in 2015. Many seniors will not be able to afford to pay them. Senior might not notice the increase until they receive their first social security check.

“Starting in 2015, applicable large employers will need to identify whether eligible employees have been offered employer-sponsored health care coverage and whether that coverage meets the standard for minimum essential coverage, among other requirements.

Employers will also be required to track employee eligibility for health care coverage, including number of hours worked, etc.”

There is no way employers can track this information manually anymore. They will have to hire a benefits manager to keep track of something that is so fluid as to will be impossible to keep track of.

Employers’ overhead will rise. The large employers will decide it is cheaper to pay the Obamacare’s penalty and force their employees to buy insurance on the federal health insurance exchanges.

How can all these people buy insurance wisely between November 15, 2014 and December 31, 2014 to be insured in 2015.

This will create havoc in the healthcare system.

Creating havoc is the goal of President Obama’s plan to transform America. It follows Saul Alinsky’s game plan precisely. It will lead to population fear. Population fear will lead to a government controlled single payer healthcare system.

The public is presently experiencing a great deal of fear with the potential for an Ebola epidemic. The resulting hospitalizations and deaths that might occur from an epidemic will intensify this fear.

This CDC and the Obama administration keep giving us illogical reason for why they refuse to stop flights from West Africa to the U.S.

The airport screenings’ protocols are illogical. The training protocols have been unsuccessful.

Havoc will intensify if the United States experiences an influenza outbreak this winter. People will not know whether they have the flu or Ebola. People will overrun the nation’s hospital ERs.

Public and private health insurance policies might not cover the care needed to diagnose and treat these patients.

People will be put in isolation in the hospitals. The patient’s contacts will have to be quarantined. The economy will come to a standstill.

The only option remaining is for the people to beg the government to take over the healthcare system.

I do not know if President Obama and his administration are brilliant or incompetent.

I suspect he is brilliant.

In either case his goal of socializing medicine will be achieved

Are President Obama and his administration competent enough to control and run the healthcare system?

What is your guess?

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

There had been three failures at the time he declared Obamacare a success this month.

1. The Obama administration announced that accountable care organizations (ACOs) in the Pioneer ACO model and Medicare Shared Savings Program (MSSP) have generated more than $372 million in total program savings for Medicare ACOs over the program’s two-year span.

The details of the Pioneer ACO models’ savings are difficult to follow.

An estimated total model savings of over $96 million and at the same time qualified for shared savings payments of $68 million

Eleven Pioneer ACOs earned shared savings, 3 generated shared losses, and 3 elected to defer reconciliation until after the completion of performance year three.

The organizations showed improvements in 28 of the 33 quality measures and experienced average improvements of 14.8 percent across all quality measures.

The mean quality score among Pioneer ACOs increased by 19 percent, from 71.8 percent in 2012 to 85.2 percent in 2013.

I first read it in 1959, two years after it was published. It is a weak love story but a powerful critique of government policy and the effect of expanding government control over society.

I did not think about it much during medical school. I thought about it when the government started to control my medical practice.

In 1984 my son, Brad, insisted I read Atlas Shrugged again. It describes exactly the effect the government was having on the practice of medicine.

I did not understand why Democrats in congress and the Democratic Party members become were so angry with Ayn Rand and her philosophy. I thought Democrats were problem solvers for the benefit of the people.

I finally realized that Ayn Rand’s writings are a dangerous threat to the Democrats’ progressive agenda. The agenda is the government’s control over society turning free citizens into clients of big government.

In this election year the Democrats have decided to combine their anti-Rand rhetoric with a Saul Alinsky tactic.

The Democrats are trying to immobilize Republicans’ replies through a replay of their anti-Rand sound bites. They are using the traditional mainstream media to spread their disinformation.

If a reader wants to know what Ayn Rand’s philosophy is read Atlas Shrugged. I suspect most critics have not read the book.

Democrats attack Ayn Rand by misrepresenting her philosophy as evil.

This year the Democrats’ attack dog is House Minority Leader Steny Hoyer (D-Md.).

In reality comprise is usually evil. If a policy or law is wrong, compromising will not fix the problem that policy or law set out to fix. According to Ayn Rand there are issues in which compromise is evil. If a law or policy does not work compromise can be evil is if is not modified by compromise.

Steny Hoyer’s warning Republicans taking over congress would only lead to more gridlock and partisanship does not logically follow the first part of his sentence.

The House of Representatives have passed about 350 bills. A 98% of the House passed bills were with bipartisan.

President Obama is always blaming his failures on President George W. Bush or his advisors.

Many of President Obama’s advisors are now blaming Republicans for their agencys’ shortcomings. Even Dr. Anthony Fauci, head of the National Institute of Health Infectious Disease division, is implying Republicans are to blame for the agencey’s lack of efficient response to the Ebola virus epidemic.

“Nor does it inspire confidence that the head of infectious diseases for the CDC is resorting to that promiscuous federal excuse—budget cuts.

Anthony Fauci recently told Congress that sequestration “has, both in an acute and in a chronic insidious way, eroded our ability to respond in the way that I and my colleagues would like to see us be able to respond to these emerging threats.”

Is this a joke? There are many other examples of shifting blame such as our foreign policy crisis in the middle east, the crisis with ISIS, nuclear Iran, Israel/Hamas and the Arab spring to name a few.

All these excuses remind me of the excuses that characters in Atlas Shrugged used when the world was falling apart.

“The looting of the fruit of their labor provoked the producers to withdraw from society. Without producers, thinkers and creators there was an economic implosion and society rapidly declined and fell into chaos.”

Every time President Obama mentions government enforced income equality or government-led opportunity I think of the villains in Atlas Shrugged such as the politician Wesley Mouch (New York Senator Chuck Schumer) or crony capitalist Orren Boyle (various green energy vampires) to name only two.

In the words of Yogi Berra, “It feels like Da Ja Vu all over again.”

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

The government has been attempting to take over the healthcare system since 1935 at the time of the Roosevelt administration.

The government took over the healthcare system 30 years later during the Lyndon Johnson administration. LBJ passed Medicare and Medicaid. It turned out that financial projections were faulty and the business model was defective.

Medicare and Medicaid provided medical care for the elderly and the poor at an affordable price at that time. Everyone loved it. At the time it was also affordable for the government.

I do not think anyone contemplated the healthcare inflation that occurred as a result of the government’s business model.

Inflationary pressure increased rapidly.

Finally, President Reagan said the government could not afford the increasing prices any more. He said enough is enough. He decreased provider (hospital, doctors, pharmaceutical company, and insurance company) reimbursement for Medicare and Medicaid services.

The reduction in reimbursement for services resulted in price shifting increases in reimbursement in the private sector.

Both the private sector and the public sector experienced increased inflationary pressure as a result of this maneuver.

It was clear by 1984 that Medicare and Medicaid were unsustainable long term.

America did not have a free market healthcare system before Obamacare. It was a hybrid system.

The country already had 90 million Americans in a single-payer system. Ninety million Americans get coverage from Medicare, Medicaid, and the Veterans Health Administration systems.

The problem is these government controlled single-payer systems did not work efficiently. They were financially unsustainable.

Obamacare expands the single party payer system to eventually cover all Americans. Obamacare simply adds on to an existing unsustainable healthcare. Raising taxes is not going to make it more sustainable.

The expanded bureaucracy will only make the system more inefficient and more prone to fraud and abuse.

President Obama is already modifying the law without congressional approval. He is trying to hide elements of this unsustainability from the American public.

The federal government’s Obamacare enrollment system www.Healthcare.gov alone has already cost taxpayers about $2.1 billion dollars according to a Bloomberg government analysis of contracts related to the project.”

The website is still not working perfectly at the backend after spending $2.1 billion dollars.

Americans will experience more of the www.healthcare.gov dysfunction after the mid term elections.

These same companies have had their fraud and abuse exposed. Nevertheless they have been rehired at the increased price by the Obama administration.

President Obama announced to Democrats last spring that Obamacare would not be an issue at the time of the midterms.

This week the administration also announced that the cost of healthcare insurance through the health insurance exchanges is decreasing next year.

It was also announced that there is an increase in the choice of insurance carriers in most states resulting in competitive premium pricing and lower premiums.

President Obama announced that Obamacare is working. He said Obamacare is a non issue in the 2014 mid term elections.

Nothing could be further from the truth.

If our elected officials cannot see President Obama’s trick play how can the public expect to understand the deception?

This is another of the manipulations of Obamacare designed to hide its impending failure from the public.

The Obama administration set up a reinsurance company funded by taxpayers that eliminates any insurance risk the healthcare insurance companies might incur in insuring enrollees.

Healthcare insurance companies are signing up and competing for market share to gain profit from this no risk insurance. They can easily afford to lower the premiums because the government will cover their supposed loses.

None of this has anything to do with patient care or the quality of patient care.

It has little to do with providing low cost insurance. The cost of insurance keeps increasing. The government pays the difference between the cost of insurance and what patients who receive subsidies pay for their premiums.

Obamacare misses the main problems in the healthcare system. Obamacare creates more dysfunction in the healthcare system.

Based on more plausible assumptions, such as those reflected in the "alternative" scenario for Medicare produced by the Congressional Budget Office in June 2012, the long-term shortfall is more than $100 trillion.

It is the responsibility of our elected officials control America’s expenditures.

Unfortunately, for American’s, this is not how a government controlled system works.

Voters must decide how long they are going to tolerate this abuse of power.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

C-Span has provided the public with important lessons on how our government is really run by televising various congressional committee meetings.

The traditional mainstream media provides us with little of the important information that comes out of these committee meetings.

C-Span’s coverage has revealed how inefficient, political and bureaucratic our government is.

Americans should elect representatives to be our spokesmen. Our representatives should do what is right for us and not for the vested interests of various special interest groups.

The latest information about Obamacare has not been reported in the media but came out in committee.

The Obama administration had announced publicly to a subcommittee in April 2014 that its "risk corridor" plan would be revenue neutral.

In English, it means that there would be no extra taxpayer dollars available to cover the losses of the healthcare insurance companies. Those healthcare insurance companies insure enrollees through the government’s healthcare insurance exchanges.

Chet Burrell, head of Maryland insurer CareFirst told Valarie Jarrett this plan would result in premium increases of 20% or more later this year as Obamacare policies come up for renewal.

He warned it would be "an unwelcome surprise" to the Democratic Party and Democrats running for reelection in November.

The Obama administration was very concerned about a 20% premium increase for enrollees in Obamacare. After a while, Ms. Jarrett assured Mr. Burrell the insurance industry would get 80% of the subsidy (bailout) they sought.

The 80% was granted by executive order without congressional approval. A few weeks later the healthcare insurance industry bailout was changed to almost 100% of the request with little notice from anyone.

The government guarantee affects all of the enrollees in Obamacare. It also permits the increase in private insurance plans.

There are 50 million people on Medicare, 65 million people on Medicaid, 9 million in the VA system, 7.3 million in Obamacare and an additional 149 million for employer-provided healthcare insurance.

It turns out that Obamacare is just another government subsidy program with the government throwing more money at the health care insurance industry while the healthcare insurance industry raises the premiums.

President Obama, by executive order, has created an unlimited Obamacare reinsurance program covering the healthcare insurance industry’s supposed losses.

According to some, the total subsidy to the healthcare insurance industry is $1.3 trillion dollars.

It’s no surprise that many more healthcare insurance companies are planning to participate in President Obama’s health insurance exchanges.

If a healthcare insurance company sells insurance without risk it is a great deal. Taxpayers are assuming the risk for the insurance companies. Some insurance companies are decreasing their rate to capture a larger market share. They will cash in on the Obamacare subsidy.

This subsidy is a mistake. It adds little value in improving the nation’s health. President Obama does not seem to care about how much money he is wasting.

It is all about politics.

The subsidy adds much political value to Obamacare because it postpones the 20% premium increase at this midterm election.

However, the healthcare insurance industry is finding it necessary to increase premiums an additional twenty percent despite the tremendous subsidies. This is the result of the enrollees who acquired insurance but did not pay the premiums and used the services and the terrible demographic distribution of enrollees who paid their premium. Eighty-five percent of the people who paid premiums were high risk patients with pre-existing illnesses.

The rules of Obamacare have turned out to be totally improvised. The Obama administration changes the contents of the law in order to keep it afloat without the approval of congress.

The plot thickens. A challenge is in the courts right now on whether the government health insurance exchanges are allowed to provide subsidies to enrollees.

The law specifically states that tax credits are only available through the state health insurance exchanges and not the federal health exchange.

Funny things are going on in the courts. One panel said yes, the subsidies may be provided by the federal health insurance exchanges. The D.C. panel of three judges said no.

Attorney General Holder appealed to the D.C. court of appeals. He wanted the judgment determined by the entire panel of 9 judges not a subpanel of 3 judges. The 3 judges’ decision was overruled by the 9 judge panel.

I still do not understand how tax credits are given to people who do not earn enough to apply a tax credit to their income tax. Why do they receive a subsidy? They pay no federal income tax.

I hope Americans wake up soon to the fact that Obamacare is deeply flawed and cannot work. The only thing that will overturn it will be an overwhelming taxpayer protest.

This midterm election cycle is a good place for voters to start. A Republican majority of the senate might be able to stop Obamacare in its tracks.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

In the past the New York Times reserved this spot for the most important story of the day.

This story was the most important news story on Sunday September 200h 2014. The Times thought it was more important than a story about the economy, ISIS, the mid-term elections, Israel, Hamas or Iran’s nuclear ambitions.

The story intended to inflame the New York Times’ readers so they would be angry at the medical profession.

The problem is that the story is peppered with misinformation and disinformation.

The New York Times writer used a typical Saul Alinsky tactic. Her goal was to prevent the opponents of the story from responding intelligently.

Public opinion will be on her side because the New York Times is supposed to be a credible source.

Saul Alinsky’s rules instruct one to lie if necessary. The next step is to frighten consumers into thinking the system under attack cannot work.

Peter Drier did not read or modify the consent forms. He should have made the hospital and his doctor liable for any unauthorized expenses, providers, or events.

Peter Drier is a bank technology manager. Banks have their own small fine print intended to keep consumers liable and uniformed.

Peter Drier should have modified the consent forms before he signed them. He can refuse to authorize treatment or payment to any provider or procedure performed in the hospital that was outside of his insurance network.

In Network providers have to agree to accept the negotiated fee. If they need an additional provider it must be a provider that will accept the negotiated fee of his insurance company.

A bank technology manager who had researched his insurance coverage, Mr. Drier was prepared when the bills started arriving: $56,000 from Lenox Hill Hospital in Manhattan, $4,300 from the anesthesiologist and even $133,000 from his orthopedist, who he knew would accept a fraction of that fee.

Every consumer should find out if their providers are in their insurance network .

All of those prices are ridiculous retail prices. The real question is how much did his insurance company pay and how much is he liable for.

Peter Drier did not do a very good job in researching his insurance company’s coverage. A third party payer would never approve a $56,000 payment to the hospital for the proposed procedure.

Hospitals bill very high retail prices. They will negotiate a price that is 50-90

5 lower than the retail fee.

The author, ELISABETH ROSENTHAL, has a list of recent articles criticizing the healthcare system about exorbitant retail pricing.

COLONOSCOPY: Colonoscopies Explain Why U.S. Leads the World in Health Expenditures

PREGNANCY: American Way Of Birth, Costliest In The World

JOINT REPLACEMENT: In Need Of A New Hip, But Priced Out of the US Market

HOSPITAL PRICES SOAR: A Stitch Tops $5000

All of these articles criticize the retail price providers charge. They do not tell the reader what the providers receive as reimbursement by the government or the healthcare insurance company.

Consumers are the victims of the constant effort to try to reduce healthcare costs and stick consumers with the bill.

Obamacare has driven the healthcare insurance industry to raise premiums and decrease coverage in order to cover their supposed actuarial risk.

The decreased reimbursement by the healthcare insurance industry has driven providers to increase their fees for service. The hope is to occasionally catch a consumer who is uninsured and liable for the fee.

The uninsured consumer cannot afford the fee and therefore will not pay the fee. The provider then has to sue the consumer to collect whatever they can. The cost of the suit is not profitable for the provider. He usually writes off a loss.

President Obama and the government control advocates will use the resulting chaos in the marketplace to prove that a free market for healthcare system does not work. Therefore the country needs a government controlled single party payer system.

The problem with these horror articles is they frighten consumers. They do not address the reason that the healthcare industry costs $2.7 trillion dollars a year.

The chaos in the marketplace is the result of the government (Obamacare) involvement into the free market system.

I am also not sure if the $2.7 trillion dollars is from retail charges or negotiated payments. The answer to the question is totally opaque.

The reasons for the increasing costs are many.

Americans are becoming less healthy because they are not being responsible for their health. It is hard to maintain weight when almost every restaurants main dish is higher than their daily caloric allotment.

President Obama and the healthcare insurance industry were terrified about adverse selection by the people signing up. Both worked hard to get young people with no preexisting illnesses to sign up so the insurance premiums would not increase next year.

Basketball, baseball and football stars were recruited to advertise Obamacare’s benefits on TV and encourage enrollment.

The population, in the uninsured individual insurance market, was only 14 million out of a population of 350 million people. Three hundred and thirty six million received waivers from Obamacare for one reason or another.

What will happen when 336 million must participate in Obamacare? The percentage of participants in the population will be tiny if the individual market is a guide.

Seven million of the fourteen million lost their healthcare insurance because of Obamacare’s requirements. Eight million signed up for healthcare insurance under Obamacare. This represents an increase of only one million and not and increase of eight million.

Of the 8 million, 85% or 6.8 million people applied and received government subsides. These subsidies were supposed to be tax credits.

The www.healthcare.gov did not have a functional back end to the website to check if these people were lying about their income, job status, and even citizenship.

If people intentionally misstated information, they were warned they could be charged with perjury. I assume President Obama will waive that charge.

Only citizens and legal immigrants are eligible under the law for subsidized coverage.

“Only 18% have opted for bronze plans, which offer lower premiums, balanced by deductibles of $4,500 for singles/$9,000 for families.”

Many consumers can hardly afford the bronze plans with subsidies much less the high deductibles. Those consumers will be forced drop out of Obamacare.

“The Associated Press reports that of the 5.4 million people who signed up for health insurance through the federal marketplace 2 million submitted information that does not match up with federal data.”

The discrepancies could affect their subsidy adversely. Applications were accepted on boy scouts’ honor. The subsidies were determined on the basis of the information on the application. These people will owe the government the difference plus a penalty. They are also liable for perjury.

Despite having had three years and more than $600 million to work with the federal governmentand its chosen contractor could not build a functional website. It cost an additional $200 million dollars and four months to get the front end to work.

The $600 million to build www.healthcare.gov was more than it cost Apple to develop the iPhone. Apple is an American company with American jobs.

The White House has attempted to dispel concern about the website being dysfunctional.

However, the report of over 2 million falsified applications has reignited the questions of government incompetence and misleading information about the dysfunctional website as the enrollment period approached.

CMS administers Medicare and Medicaid. CMS was restricting payment for outpatient procedures and tests done in freestanding practicing physicians’ offices while paying higher fees for the exact same outpatient hospital procedures and tests.

As rules and regulations and the complexity of the business of practicing medicine in private freestanding outpatient clinics increased physicians sold their practices to hospital systems.

The government and the healthcare industry encouraged these sales by increasing the complexity of running a private practice.

The probable logic was they would only have to deal with one entity (the Hospital System) rather than 600 individual doctors or clinics using that hospital system.

The government’s excuse for cutting out freestanding individual practices and clinics was efficiency and patient safety.

The hospitals were overjoyed to be able to buy physician practices.

“As the Affordable Care Act attempts to steer people away from pricey hospital inpatient admissions, hospitals have begun buying up doctors’ offices in hopes of increasing their revenue and market share.”

The hospital systems’ then discovered they were losing money by buying physicians’ free standing practices.

In essence they were trying to buy physicians’ intellectual property and surgical skills because the traditional brick and mortar hospital building was becoming less profitable. Many surgical procedures were being done as outpatient procedures.

Physicians were less productive as hospital employees than they were when they owned their own practices. They were guarantied a salary.

Hospitals did not bother to calculate the money they made from doing the entire outpatient testing and procedures when presenting the loss to the government.

Hospital systems have been selective, first buying Primary Care Physicians’ freestanding office practices. Next they started trying to buy oncology practices.

To further encourage physician owned clinics to migrate to hospital system owned practices the government and the healthcare insurance industry provided separate revenue codes to allow hospital systems to collect more for the same tests and procedures done in physicians’ free standing offices.

As hospital system merge the price will go up even further. The hospital systems are now negotiating from a position of strength. Hospital systems are making the money as private physicians’ reimbursement shrinks.

The government and the healthcare insurance industry are finding their scheme to destroy private practice was a big mistake.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone. Please have a friend subscribe

The article is about the need for prior authorization to reduce drug costs in an insured patient. As you read this, think of the increase in the insurance company’s administrative waste, and the disrespect for the physician’s time and judgment.

Millions of prior authorization letters are sent every day for drugs, hospitalizations, and treatment plans. They are the result of actions that do not fit into a healthcare insurance company’s computer algorithm.

Insurance company workers know little about medical care these prior authorizations are challenging. These workers know little about medical judgment or medical care.

The healthcare insurance industry believes it is an effective way to prod physicians away from more expensive treatments and toward less expensive alternatives.

It makes it harder to prescribe costlier medications. In reality, it is a wasteful administrative nightmare.

But Mr. V. had changed insurance companies, and now one of his medications required a prior authorization. The last thing I wanted was for him to be turned away at his pharmacy and have his blood pressure spiral out of control, so I called right away to sort things out.

Twenty minutes of phone tree later, I discovered that the problem was that I had exceeded a pill limit for one of his medications. Mr. V. needed to take 90 of those pills each month for the high dosage that his blood pressure required. I patiently explained this to the customer care representative.

Equally patiently, she told me that 45 pills a month was the maximum allowed for this particular medication.

Three more phone trees and three more customer care representatives later, my patience was flagging. Apparently a request for 90 pills was flummoxing the system. Representative No. 4 went down her checklist. “Would taking 45 pills per month instead of 90 pills adversely affect Mr. V.’s health?” she asked.

At first I thought she was joking. “Well,” I replied, “it would probably make his blood pressure shoot up in the second half of the month.”

She paused, then asked her next question with the encouraging uplift of suggestion. “Has Mr. V. ever tried 45 pills per month instead of 90 pills?”

Then I realized that she was not joking. “Are you out of your mind?” I hollered into the phone. “It’s taken years — years! — to find the right combination of meds to control his blood pressure without killing his kidneys or making him dizzy or nauseated or depressed or ruining his libido or running his potassium off the charts or breaking his bank account. Do you really think I’m going to randomly jiggle the dosages just for the hell of it?”

“A simple yes or no will suffice, doctor.”

This interaction demonstrates a lack of respect for the physician and his judgment, and a lack of understanding of the patient’s illness. I have said over and over again that you cannot commoditize patients’ illnesses or physicians’ skills.

If the insurance company’s computer system has a beef with physicians’ judgment it should get a second opinion by a neutral expert physician in the field of hypertension to review the chart and the patient’s illness.

“I’m all for controlling medical costs and trying to apply rational rules to our use of expensive medications and procedures. But in the current system, everything seems to be in service of the corporate side of medicine, not the patient. The clinical rationale and the actual patient — not to mention the doctors and nurses involved in the care — are at best secondary concerns.

In the end, we were able to keep Mr. V.’s blood pressure under control. My blood pressure, however, was a different story.”

These interactions go on daily and waste physicians’ time and energy. Physicians have no ability or representatives to fight back. However, they are ready to fight back. All they need is someone to come up with a plan.

A good start is changing the paradigm of healthcare insurance so that it is a consumer driven healthcare system with consumers being in charge of their healthcare dollars and their health.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone. Please have a friend subscribe

I must start this article with a disclaimer. I am a retired Clinical Endocrinologist that practiced Clinical Endocrinology for 30 years. I became involved in medical politics because I wanted to help make Clinical Endocrinology a household word. We succeeded at the American Association of Clinical Endocrinologists to make Endocrinology a household word.

At that time I saw that the medical profession was slowly being destroyed. I wanted to make whatever contribution I could to save the medical profession in order to preserve the care patients were given and help promote the progress in medical research.

Today I see the delivery of medical care diminishing and the infrastructure of medical care being destroyed by the Obama administration’s ideology coupled by government bureaucrats as well entrepreneurs that see profit in business opportunities that do not add value to medical care.

I do not have a horse in this arena anymore. The only vested interest I have in the healthcare system is that an effective medical care will exist when I need it.

How do we create systems of care that promote high performance? I do not believe it is by a series of top-down highly specific mandates. I believe it is by creating general guidelines for physicians and providing tools to help physicians advance medical therapy using advanced technology.

It boils down to policy makers’ view of physicians.

Are physicians knights to be empowered in their service of patients?

Are physicians knaves not to be trusted?

Are physicians pawns in a healthcare system to be manipulated by the powers that be?

At present, healthcare policy makers view physicians as knaves and pawns. This view has to change in order to have a functional healthcare system because people behave has you project them to behave.

The environment is conducive to the destruction of the healthcare system. Barriers that inhibit effective medical care and increase the cost of medical care can easily be overcome if the Obama administration wanted to fix them.

The public and future administrations have to understand the barriers to effective medical care in order for the healthcare system to arrive at a future state that is not on the way to self-destruction.

America’s healthcare system needs a new vision of physicians and patients. The change in vision would result in a new business plan built around a new system of care.

The healthcare systems needs input from physicians and patients. They are the two most important stakeholders in the healthcare system. Without physicians or patients there would not be a need for a healthcare system.

The promotion of a vibrant patient/physician relationship is the keystone to a viable future state of the healthcare system.

I will first list the barriers and then explain them and their solutions in my next blog. Some of the barriers have been covered in previous blogs.

President Obama is in the midst of a leadership crisis on many fronts. A large number of voters have no idea of the details of each crisis or scandal.

They figure they elected a President who will not only take care of a crisis when it develops but he will look after America’s best interests.

There are other voters who have become news junkies. They are interested in each crisis. The source of their information is the traditional media. The traditional media provides filtered sound bites that lead them to erroneous conclusions.

People are mistrusting the administration and the traditional media because they are realizing that are being fed disinformation. They realize they are being manipulated. It is becoming clear that the administration is not defending the constitution and the people’s freedoms.

The defects in Obamacare are affecting people directly. All of a sudden seniors cannot find a physician who will take Medicare.

If they sign up with a concierge physician they receive no reimbursement from the government for Medicare premiums they have paid.

People with employer sponsored healthcare insurance are having difficulty finding a physician unless they pay a fee to a concierge physician.

Their portion of the healthcare insurance premium has increased with a threat of higher premiums next year. A 15-50% increase is expected. Their copays and deductibles have also increased.

The employer sponsored healthcare insurance plans are going to be available to only full time employees.

Last month there was an increase in employment of 288,000. However there was a decrease in 708,000 fulltime jobs and an increase in 1,115,00 part time jobs because of Obamacare and its mandate to provide healthcare coverage for people who work more than 35 hours a week or face a penalty.

“Writing in the Wall Street Journal, Mortimer Zuckerman — real estate developer and editor in chief of U.S. News & World Report — says yes. Some data seem convincing. In June, part-time jobs (defined as less than 35 hours a week) increased by 1,115,000, reports the Bureau of Labor Statistics (BLS); full-time jobs fell by 708,000.”

It turns out many people lied on their enrollment applications and they will not receive the subsidy. The Obama administration took their enrollee's word because it did not have the infrastructure to check the applications. These people cannot afford the premium now much less after the subsidy is removed and back payment to the government is made.

This will reduce the 8 million claimed valid enrollees to below 5 million enrollees.

I do not think President Obama is going to demand back payment. This is not the first time President Obama has changed the law without consulting congress.

The law states that people can qualify for tax credits. A tax credit is defined as a deduction off the income tax due. People making under $40,000 do not pay income tax. Some receive a check from the government.

How was a tax credit changed to a subsidy?

The law specifically states that the state health exchanges and not the federal health insurance exchanges can provide the tax credits. Thirty-six states have not set up state health exchanges.

Those thirty-six states predicted that the exchanges would be a failure and a tax burden to its citizens.

Many of the remaining states that set up health insurance exchanges are failing.

The federal government set up health insurance exchanges in those thirty-six states instead. The federal health insurance exchanges have not been a success despite the statements by the New York Times and Paul Krugman to the contrary.

President Obama’s pledge to bail out the healthcare insurance industry if the industry does not make as much money as they expected to make because of the demographic profile of the people who sign up is another sign of failure. It points out how dependent the Obama administration is on the participation of the healthcare insurance industry.

Where is President Obama going to get the money to pay for all the pledges? The CBO now predicts Obamacare create a 1 trillion dollar deficit rather than an excess over the next decade. This is after collecting increased taxes for 6 years before full implementation of Obamacare.

There are many other defects in Obamacare. It is a failure.

The Obama administration with the help of the traditional media is trying to distract the public from the facts by withholding facts and feeding the media confusing facts, disinformation and lies about Obamacare’s success.

The administration blames Obamacare’s difficulties on the Republicans using non-facts.

The Obama administration can get away with this for only so long. The middle class is realizing the economic burden Obamacare has created for the middle class and the economy.

The middle class is realizing this because the facts are affecting them directly.

With the atmosphere of mistrust, and distrust created by the economy, the decrease in the value of the dollar, the lies and withholding of information about Bengasi, Fast and Furious, the IRS, the Ukraine, Syria, Iraqi, Afghanistan, Iran debacles, and the VA scandals it is going to take a lot for the people to regain its trust in President Obama.

This is a direct contradiction to the Obama administration’s projection of the growth of health insurance exchanges.

“In April 2014 after open enrollement closed, the staff of Connect for Colorado projected 13 percent of people enrolled will drop or not pay for policies in fiscal 2015, but now they are expecting about 24 percent to drop their policies, according to the latest model.”

“And in fiscal 2016, the revised figures show dropped policies going from the 16 percent projected in April to nearly 22 percent.”

The Colorado Health Insurance Exchange’s chief financial officer Cammie Blais said the staff is using the higher drop rate in more recent models because that is how national figures are tracking.

President Obama and the Obama administration are aware of these figures. As usual they are keeping it from the public.

The federal government was not set up to verify the information given on the enrollment form at the time of enrollment.

President Obama told everyone he would take his or her word for the information’s accuracy. This was a tremendous defect in the Obamacare system.

Many enrollees are going to lose part or the total subsidy provided by Obamacare. For some, the original subsidy was not enough to reduce the burden of insurance. In many cases the burden included high deductibles and copays that were unaffordable.

Many of the remaining fifteen percent of the enrollees had preexisting illnesses and could not buy insurance on the open market and/or were making over $50,000 a year.

Their premiums plus deductibles and copays are so high that enrollees making over $50,000 a year realize they cannot afford the insurance and have to drop out of next year’s exchange.

As a result of this adverse selection healthcare insurance industry’s premiums are going to skyrocket in 2015 as they have skyrocketed in 2014.

If the government starts convincing the majority of the public that the free market solution of the health insurance exchanges doesn’t work, the only choice will be a single party payer system for the entire population.

The VA system is an example of a single party payer system run by the government. It is a bureaucratic mess that is inevitable with a government run single party payer system.

A large bureaucratic single party payer systems relying on rules and regulations will end up with as non-transparent bureaucracy built for the benefit of the bureaucrats and not the people.

I think the public understands this. I think the Obama government is out of touch with the people.

President Obama ought to reexamine his premises.

The Obamacare system being built is destined to fail. It is not a consumer driven free market system. It does not follow that a single party payer system will work.

In reality none of the government controlled single party payer systems throughout the world work. They are just free. However, these systems are unsustainable.

The 8 million enrollees that President Obama ran his Obamacare victory lap on continues to dwindle at an accelerated rate.

If the DC appeals court rules against the federal government ability to provide subsidies, the number of enrollees will decrease even further.

The law states that only State health insurance exchanges can provide subsidies.

Obamacare is getting further and further away from being functional.

The Obama administration and the traditional media are working very hard to keep this information from the general public.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone. Please have a friend subscribe

Many of my readers have asked me to explain drug pricing. I have not covered the pharmaceutical industry’s pricing in this blog because I have not been able to figure out drug pricing.

I do know there is a lot profit in both the retail and wholesale drug business. I know government pricing is different that benefit management pricing. I know there has been a growth in drug benefit management companies.

My sense is neither the pricing for Medicare Part D or private insurance drug benefits are for the patients’ advantage.

I recently asked a good friend Dr. Dale Fuller, a retired radiation oncologist, to explain the outrageous cost of oncology drugs (Drugs used to treat patients with cancer).

I wanted to know the reason the government pays almost twice as much to hospitals for the same treatment patients get in the oncologist’s office even though the treatment is given by the same oncologist.

I have added a couple of comments to Dr. Fuller’s note into the body of his reply.

Dr. Fuller writes,

"Is pharmaceutical pricing weird, or what?"

Dale Fuller M.D.

"Lately I have been thinking about pharmaceutical pricing, and as an old pharmacist turned radiation oncologist, it was the pricing of cancer drugs that caught my interest.

Then, my wife showed me some information about a product called “Symbicort” that she uses on a regular basis.

Introduced into the US in March of 2009, it goes off patent in 2014. The other day she brought home a 90 day supply for which she had paid $120.00, and Medicare part D allegedly paid $839.89. At least, the package from Walgreen’s informed her that her “insurance had saved her that $839.89”.

The $839.89 plus the $120 or $959.89 is going to be charged against her Medicare Part D donut.

During the initial coverage phase, you pay a copayment or coinsurance, and your Part D drug plan pays its share for each covered drug until your combined amount (including your deductible) reaches $2840.

When you spend more than $4,550 out-of-pocket, the coverage gap ends and your drug plan pays most of the costs of your covered drugs for the remainder of the year.

The patient will then be responsible for a small copayment. This is known as catastrophic coverage.

In 2014, Medicare will pay 28% of the price for generic drugs during the coverage gap. You'll pay the remaining 72% of the price.

What you pay for generic drugs during the coverage gap will decrease each year until it reaches 25% in 2020—in 2015, you'll pay 65% of the price for generic drugs during the coverage gap.

Confusing isn’t it.

That would be a total of $959.89 for her 3 months’ supply of medication, or $319.96 a month, or $2.67 a squirt, of which there are four a day. Who knows how much Uncle Sam actually paid Walgreen’s for his share of the bill.

However a senior cannot buy this inexpensive brand named Symbicort using his Medicare Part D drug plan because he would be buying it from a Canadian Pharmacy.

So much for competitive innovation in a global economy. Government control trumps innovation.

Similar abstruse drug pricing strategies exist in abundance in the field of medical oncology.

Consider first the situation in the office of the medical oncologist. The physician purchases pharmaceuticals from a supplier. He must retain at least a basic inventory of frequently used products, some of which are very expensive.

The “acquisition cost” becomes the basis for the reimbursement the doctor receives from Medicare for the drug. To the acquisition cost the doctor was allowed to add 6%, which was intended to cover the preparation for administration.

The actual infusion of the medication in the doctor’s infusion room, including the cost of the nurses working there, was reimbursed at a rate of $133 per hour (“chair time”). Keep that figure in mind.

The US budget debacle in which Uncle Sam cut everything he paid for by 2%, actually amounted to a 33% reduction in the 6% the doctor was allowed, leaving ~4% to underwite the preparation for administration of the drug required for the care of a Medicare patient.

There are other patients who come to the infusion room, as well. Some have private insurance, and some have no insurance at all.

The private insurance may carry a different level of reimbursement for pharmaceuticals from that paid by Medicare, or it may not.

Very few uninsured patients have the wherewithal to pay out of pocket for the cost of their care. The doctor has two choices in handling their situations: charity or referral to a hospital where the cost of chemotherapy agents and their administration is handled in a different way.

The absence of any significant profitability for many medical oncologists has resulted in the closure of at least 400 practices between 2007 and 2012, and closures continue to this day. Patients in these situations have been forced to seek outpatient infusion services in local hospitals, where administration reimbursement to the hospital is an average of $299 per hour in comparison to $133 in the doctors’ offices.

It is said that hospital outpatient infusion services use more drugs (see below for how they are acquired), charge higher prices, and require higher co-pays from patients. Go figure.

And, don’t forget the drugs! Doctors are now reimbursed by Medicare at acquisition plus 4%, while hospitals, under “340B” programs enjoy a margin of about 30% versus the doctors’ 0-2%.

Remember the Symbicort example I started with? The 304B acquisition price for Symbicort is listed at $88! Even with a 50% markup for a patient, a month’s supply would come to $132. Go figure.

The evolution of this mess has prompted a congressional advisory organization called MedPac http://www.medpac.gov/ to call for changes to equalize payments for oncologists’ care in their offices as compared to payments for services provided in hospital outpatient departments. And, who can argue against the creation of a level playing field?

Symbicort is now generic. I tried to find the price of the generic drug. I could not without providing a prescription. Go Figure. Is this transparency?

Patients and physicians are being taken advantage of here. They are the pawns that drive the profits in the healthcare system.

Someone has to stop it for the sake of good medical care delivery.

I wish to thank Dr. Dale Fuller for this submission.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone. Please have a friend subscribe

We do not know how many people will lose their insurance in the group markets as large corporations are only hiring people to work less that 29 hours a week to avoid the corporations’ penalty resulting from the Obamacare mandate.

President Obama delayed implementation of Obamacare in the group market by granting waivers to the group market for one to two years in order to avoid exposing Obamacare to an increase in the uninsured.

The real truth is the closing of the enrollment period was delayed twice. The Obama administration paid millions of dollars in television ads and endorsements by celebrities encourage young people to sign up. Enrollees were not supposed to be counted as enrolled unless they paid the first month’s premium.

“Sebelius should read her own agency's report. It states quite clearly that "it is important to note that the Marketplace plan selection data as of the end of the open enrollment period do not represent effectuated enrollment (e.g., those who have paid their premium)."

Many who paid the first month’s premium have not paid their second month’s premium because they could not afford it. Even some subsidized enrollees cannot afford the premium.

Even worse, the HHS inspector general provided the first independent look at widespread issues the government is having effectively fact-checking the information applicants have put on their applications.

President Obama informed us that applicants lying on the website applications and receiving government subsidies for 2014 will be penalized on their tax return in 2015.

“The government needs to determine applicants' eligibility in order to verify they can enroll and, in some cases, get government subsidies.”

Eighty-five percent of enrollees are receiving government subsidies. The report only covers people enrolled as of December 2013 when the total nuber of enrollees was only 3.5 million.

“ Without that step (government verification), coverage could be jeopardized. Critics fear these issues also could cause chaos during the 2015 tax-filing season, as many would have to pay back subsidy money they were not entitled to.”

According to the report, those running the federal marketplace are having trouble resolving problems of eligibility for subsidies.

"The federal marketplace was generally incapable of resolving most inconsistencies," the report said, claiming the government could not resolve 89 percent of the problems.

So far Paul Krugman is zero for two.

The American people will never know the truth because of the lack of transparency.

The truth does not matter to Paul Krugman or President Obama.

The media is the message. The American public is getting an untruthful message from the Obama administration through a non-critical traditional media. Wait until the taxpayers realize what the bill will be.

3. “More people will lose coveragecancelled by Obamacare than gain it.

The real truth is there is something wrong with the Gallup survey of 3400 people. There are more people who lost insurance that had insurance previously when one compiles insurance policies lost as in section 1.

Insurance premiums have only decreased for people making less than $50,000 because they receive government subsidies. The government pays the difference for those receiving subsidies.

“Among plan switchers, 39% have higher premiums. In order to get the 46% number of switchers who had lower premiums, government subsidies had to be taken into account.”

According to the Kaiser report four in ten people in ACA-Compliant Plans say it is difficult to pay monthly premiums.

The majority of the Non-Group Enrollees (independent market) are confident about being able to pay for routine care with the high deductibles from the exchanges. They are less confident they will be able to pay the deductibles for a major illness.

Obamacare is not affordable according to the Kaiser family foundation survey.

The Obama administration is heavily subsidizing people who are making less that $50,000 a year. The taxpayer is paying for the subsidy. It will be even worse for taxpayers when the healthcare insurance companies make less that their stated goal.

President Obama has by executive order put machinery in place to bail out the insurance industry to deliver the insurance industry’s expected profit at the taxpayers’ expense.

The real truth is that the President needed 39% enrollment by young persons in order to make Obamacare financially viable in the individual healthcare insurance marketplace. President Obama ended up with only a 28% enrollment of young people.

Does anyone believe the Obama administration when they tell us there is no inflation? If you leave food and fuel out of the index there is no inflation. Food and fuel is what everyone buys and inflation is skyrocketing.

Health insurance premiums are also skyrocketing. Deductibles and co-pays are becoming unmanageable. The profits of the healthcare insurance industry unconscionable.

“Leading the charge is Excellus Health Plan, which is seeking to sock more than 24,000 customers with a 19.7 percent hike.”

“Health Republic Insurance of New York — the largest on the exchange with more than 68,000 members — requested a 15.2 percent increase for individual plans.”

Paul Krugman seems to have no interest in the facts.

Paul Krugman says, “It’s about politics and ideology, not analysis. But while this observation isn’t particularly startling, it’s worth pointing out just how completely ideology has trumped evidence in the health policy debate.”

Paul Krugman’s ideology trumps evidence. He is not even close to the truth. It is pure disinformation.

He is the one that is zero for six not his critics.

President Obama and Paul Krugman are concealing the truth about Obamacare’s failures.

What is worse is the traditional media and in particular the New York Times is letting them get away with it.

What the public needs to do is obvious.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone. Please have a friend subscribe